ABSTRACT: To evaluate the influence of "true" versus "sham" acupuncture on pregnancy rates (PRs) in women undergoing IVF.
Randomized controlled trial, double-blinded with independent observer.
Academic infertility clinic.
One hundred sixty patients <38 years old undergoing IVF with or without intracytoplasmic sperm injection.
Subjects were randomly allocated to the true or sham group and underwent acupuncture 25 minutes before and after ET. Subjects completed a McGill Pain Questionnaire regarding their clinical symptoms during ET.
Clinical PR and clinical symptoms during ET.
While the overall clinical PR was 51.25%, there was no significant difference between the arms of the study (true = 45.3% vs. sham = 52.7%); 33.1% of the patients had ultrasound-documented singleton pregnancy, and 15% of patients had twin gestations, while one patient in the true arm had a triplet gestation. There were significant differences in the subjective, affective, and total pain experience between both arms. The subjects in the true arm described their acupuncture session as being more "tiring" and "fearful" and experienced more "achiness" compared with their sham counterparts.
There was no statistically significant difference in the clinical or chemical PRs between both groups. Patients undergoing true acupuncture had differing sensory experiences compared with patients in the sham arm. There were no significant adverse effects observed during the study, suggesting that acupuncture is safe for women undergoing ET.
Fertility and sterility 02/2011; 95(2):583-7. · 3.97 Impact Factor
ABSTRACT: With the advent of evidence-based medicine, much of the complex testing that infertile couples used to undergo is no longer recommended as part of the routine evaluation. Examples of tests no longer implemented include the postcoital test, Rubin test of tubal patency, endometrial biopsy, sperm antibody testing, and the zona-free hamster test. The role of routine diagnostic laparoscopy and hysteroscopy is also reviewed.
In 2010, the simplicity of the current evaluation of couples presenting with infertility is essential information for patients to know at the initial visit. Ideally, it can help alleviate anxiety and provide patients with a road-map during a visit that is often associated with stress and high emotions.
Obstetricians & Gynecologists, Family Physicians.
After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the current recommendations for evaluating infertile couples; examine the various ways to assess ovarian reserve, the uterine cavity, and fallopian patency; and appraise the controversy surrounding diagnostic surgery.
Obstetrical & gynecological survey 01/2011; 66(1):31-41. · 3.10 Impact Factor
ABSTRACT: To characterize the early experience of a clinical program designed to provide strategies for fertility preservation to female cancer patients about to undergo chemotherapy or radiation therapy.
Retrospective chart review; case-control study.
Academic medical center.
Sixty-five female cancer patients and 57 age-matched infertility patients.
Enrollment in a program for fertility preservation.
Choice of active participation, fertility preservation option selection, clinical outcomes of patients undergoing oocyte retrieval, attitudes regarding embryo disposition.
Of 65 patients referred to the program, 18 declined to undergo embryo, oocyte, or tissue cryopreservation. Six were found not to be eligible for medical reasons. Of the remaining 41 patients, 35 chose to cryopreserve embryos, four chose to cryopreserve oocytes, and two chose to undergo ovarian tissue freezing. Fewer oocytes were recovered from the embryo cryopreservation group when compared with an age-matched control group, but the mean number of zygotes generated was similar. Attitudes regarding embryo disposition were different between the two groups. No serious clinical sequelae resulted from participation.
Fertility preservation techniques employing available technology may provide safe and practical options to female cancer patients facing chemotherapy or radiation therapy. A significant number of otherwise appropriate participants decline active management. Cancer patients display different attitudes regarding embryo disposition when compared with infertility patients without cancer.
Fertility and sterility 05/2009; 94(1):149-55. · 3.97 Impact Factor
ABSTRACT: To search for differentially expressed genes in cumulus cells from two groups of oocytes with different developmental outcome in vitro.
Analyses of gene expression in human cumulus cells from oocytes that failed to fertilize in vitro (group A) and those that developed into normal-appearing embryos on day 3 (group B).
University-based facilities for clinical service and research.
Women undergoing IVF treatment for infertility.
Cumulus cells were collected from oocytes that were aspirated from ovarian follicles for IVF. The oocytes were cultured individually for IVF and embryo development. Total RNA was extracted from the cumulus cells for gene expression analyses.
General gene expression profiles and relative abundance of pentraxin 3 (Ptx3) mRNA.
DNA microarray analysis identified 160 genes, including Ptx3, that were differentially expressed between cumulus cells in group A and group B. Quantitative analysis confirmed that the relative abundance of Ptx3 mRNA in cumulus cells was highly associated with oocyte development.
This study demonstrated that changes in the expression levels of 160 genes, including particularly Ptx3, in human cumulus cells may be indicative of the quality of their enclosed oocyte.
Fertility and Sterility 05/2005; 83 Suppl 1:1169-79. · 3.56 Impact Factor
ABSTRACT: To examine possible relationships between endometrial thickness and treatment outcome after IVF and embryo transfer, and to explore the role of potential confounding factors that may influence such relationships.
A university-affiliated clinical IVF center.
Patients undergoing IVF-embryo transfer with their own oocytes.
Endometrial thickness was determined on the day of hCG administration, 2 days before oocyte retrieval. Clinical pregnancy was confirmed by ultrasound observation of fetal heart activity.
The study analyzed 897 IVF-embryo transfer cycles. Treatment outcome (clinical pregnancy) after IVF-embryo transfer was positively associated with increased endometrial thickness and peak E(2) concentrations in serum, and negatively associated with advanced age. Endometrial thickness was dependent on peak E(2) concentrations in serum, but was independent of patient age or duration of ovarian stimulation. Thin endometrium reduced PRs in relatively young patients (<38 years old), in patients who required more than 10 days of gonadotropin stimulation, or in patients whose embryo transfers consisted of poor quality embryos.
Increased endometrial thickness was associated with improved treatment outcome, but this association was dependent on patient age, duration of ovarian stimulation, and embryo quality.
Fertility and Sterility 03/2005; 83(2):336-40. · 3.56 Impact Factor
ABSTRACT: Endometrial biopsies are of little value in the evaluation of infertile couples. Their usefulness in the evaluation of couples with repeated early pregnancy loss remains to be demonstrated.
Fertility and Sterility 12/2004; 82(5):1297-8; discussion 1300-2. · 3.56 Impact Factor
Fertility and Sterility 01/2004; 80(6):1532; author reply 1532-3. · 3.56 Impact Factor
ABSTRACT: To investigate the impact of delaying the transfer of in vitro fertilized embryos to day 5 on embryo development by comparing serum beta-hCG levels in pregnancies established after day 3 embryo transfers and those after day 5 blastocyst transfers at equivalent time intervals after fertilization.
A retrospective analysis.
Assisted reproductive technology center in an academic research environment.
Women who had an embryo transfer procedure performed after in vitro fertilization (IVF) at Northwestern University's IVF Program between January 1999 and December 2001 were included in this study.
Embryo transfer was performed either on day 3 or day 5 after oocyte retrieval for IVF (day 0), depending on the availability of good-quality embryos on day 3.
Serum beta-hCG concentrations determined 13 and 15 days after fertilization in pregnancies established by transferring cleavage-stage embryos on day 3 or blastocysts on day 5.
In singleton pregnancies, serum beta-hCG concentrations were 75 +/- 54 (mean +/- SD, n = 203) or 62 +/- 41 (n = 109) IU/mL after day 3 or day 5 transfers, respectively. In twin pregnancies, the beta-hCG concentrations were 162 +/- 105 (n = 52) or 109 +/- 55 (n = 49) after day 3 or day 5 transfers, respectively. The percentage increases in beta-hCG concentrations between the first and second measurements were similar in the two groups (day 3: 144 +/- 109, day 5: 142 +/- 63, not statistically significant).
Initial beta-hCG concentrations in pregnancies resulting from day 5 transfers were lower than those from day 3 transfers when assessed at equivalent intervals from fertilization. This suggests that embryo development or implantation may be impaired by the additional 2 days in culture.
Fertility and Sterility 01/2004; 80(6):1359-63. · 3.56 Impact Factor
ABSTRACT: To examine the relationships between peak serum estradiol (E(2)) levels and treatment outcome in in vitro fertilization (IVF) cycles after embryo transfer (ET) on day 3 or day 5.
Retrospective analysis of 697 IVF-ET cycles between January 1999 and December 2001.
A university-affiliated assisted reproduction program.
Infertile patients undergoing IVF-ET cycles.
Peak E(2) concentration in serum was determined on the day of human chorionic gonadotropin (hCG) administration. The IVF-generated embryos were cultured for 2 days until transfer on day 3. If more than four 8-cell embryos were present on day 3, embryo culture was continued until day 5 for blastocyst transfer.
Clinical pregnancy rates.
High peak E(2) levels did not adversely affect treatment outcome. After the cycles were divided according to the day of ET, high peak E(2) levels were associated with improved pregnancy rates after ET on day 5 but not on day 3.
Increasing peak E(2) levels in IVF cycles are associated with improved pregnancy rates after ET on day 5.
Fertility and Sterility 08/2003; 80(1):75-9. · 3.56 Impact Factor
International journal of fertility and women's medicine 51(1):11-3. · 0.56 Impact Factor